ROBOGAMEZ 09' ~Rising of Silent Tower:Resist or Surrender~

Registration will be extended till :- 1st September 2009

Please fill in the form using UPPER CASE letter.

For any enquirers please contact us at:
MOBILE ROBOTICS CLUB
UNITEN Putrajaya Campus:
Km 7, Jalan Kajang-Puchong, 43009 Kajang, Selangor

email - secretariat@robogamez.uniten.edu.my
phone - 603-89212020 ext 6344
fax - 03-89212116

Bank Account Number :
MOBILE ROBOTICS CLUB,
1247-0081347-52-5,
CIMB Bank

Certificate will only be given to Team Manager & 3 Team Members

* Required

CATEGORY * Note : For Open Category, each institute are only allow to send a maximum of 4 teams only.

Primary School
Secondary School
Open

Institute / School Name *

Address *

Contact Number *

Fax Number

Team Manager (Name) *

Team Manager (Address) *

Team Manager (Contact Number) *

Team Manager (E-mail)

Team Name * Not more then 10 Characters

Instructor (Name) Instructor can also be the team manager

Instructor (Contact Number)

Team Member Name (1) * (team leader)

I/C or Pasport Number (1)

Team Member Name (2)

I/C or Pasport Number (2)

Team Member Name (3)

I/C or Pasport Number (3)

Payment Note: Payment can be address to MOBILE ROBOTICS CLUB, UNITEN (above address). If you're having difficulties in making this payment now, you can still proceed with the registration. Due date for the payment is on the 14 August 2009.

Primary School : RM50/team
Secondary School : RM 100/team
Open (Local participant) : RM 150/team
Open (overseas participant) :USD 100/team

Payment Method Note: Please e-mail us your proof/copy of payment (photo).

I hereby register the above individuals as the representative team to participate in the ROBOGAMEZ 2009 Contest in accordance with the set rules and regulation. *

I agree with the terms